Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication occurring in patients with diabetes, especially in patients with type 1 diabetes (T1D), due to an insulin deficiency. Moderate hypertriglyceridemia is commonly observed in DKA but severe hypertriglyceridemia with a triglyceride level exceeding 10g/L is very rarely reported. We report a case of a 14-year-old boy who had type 1 diabetes for 4 years treated with insulin therapy, also having adrenal insufficiency treated with hydrocortisone who presented with ketoacidosis and excruciating abdominal pain. Investigations revealed hypertriglyceridemia at 64g/L, lipasemia at 1000 U/L, and stage E pancreatitis on abdominal CT. The patient was treated with intravenous insulin, rehydration, and fenofibrate with good clinical and biological evolution. Severe hypertriglyceridemia causing pancreatitis in type 1 diabetes mellitus is a rare but very serious complication of DKA in children.

Differentiated thyroid cancer is the first endocrine cancer but remains rare, representing only 1% of neoplastic pathologies. Its discovery at the occasion of distant metastasis is even rarer but not exceptional. We report the case of a 50-year-old woman with a papillary thyroid carcinoma in its vesicular variant revealed by renal metastasis at the anatomopathology of the nephrectomy specimen. The review of the literature shows that vesicular cancer is the most frequent in cases of revealed metastasis. Etiopathogenically, renal involvement occurs mainly via the hematogenous route, rarely via the lymphatic route. The treatment of metastatic CTD requires a multidisciplinary approach. In the presence of metastases revealing thyroid carcinoma, thyroidectomy is required, followed by lymph node dissection and isotopic treatment with iodine 131, which allows a white cervical map to be obtained with the direct destruction of iodine-binding metastases, followed by hormone therapy to slow down the thyroid axis. The treatment of metastases will depend on their location and characteristics. The prognosis of differentiated thyroid carcinoma is very favorable, but worsens when it is revealed by a distant metastasis. Survival is significantly better for patients with small volume and iodine-binding metastases.

Pituitary adenomas emerge from the adenohypophysis and are confined to the region of the sella turcica, however, other sites may be involved as a result of extension infiltration, or ectopic location, the ectopic involvement of the sphenoid is rare. Our case illustrated a woman patient with an ectopic invasive macroprolactinoma diagnosed as a chordoma of the skull base. In Our case, the first histological examination was consistent with a coincidental Intrasellar Chordoma and Pituitary adenoma, Immunostaining was positive for synaptophysin and prolactin with a Ki-67 index of 7%, suggestive of an invasive prolactinoma, in addition to the existence of vacuolated cells with foamy Cytoplasm resembling to hysaliphorous cells suggested the diagnosis of chordoma. However, immunohistochemical study using brachyury and S-100 protein have shown a negative stain. Thus, the diagnosis of chordoma was excluded. Thus, it is particularly important to maintain ectopic pituitary adenomas in sphenoidal or clival locations as the main differential diagnosis of chordoma; because the diagnosis can have significant implications on the management of the tumor, and can give us a golden opportunity for more conservative management (in our example managed with dopamine agonists), if the diagnosis can be made preoperatively rather than retrospectively based on histology.

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